Archive for February, 2011

In this week’s DM Update, learn which radiologists deliver more accurate breast cancer screenings and how Michigan ICUs reduced pneumonia rates in patients on ventilators. Also, learn about the new focus of the American Heart Association’s updated heart disease prevention guidelines for women for 2011.

Transformation – Realize across the population the Triple Aim™ goals of improving the health of the population, enhancing the patient care experience and controlling the per capita cost of care.

Each stage incorporates capabilities specific to transaction management, integration and the analytics necessary to support coordinated care delivery models.

The collaborative is part of the Premier healthcare alliance of more than 2,500 U.S. hospitals and 72,000-plus other healthcare sites using the power of collaboration to lead the transformation to high quality, cost-effective care.

Do diabetes Web sites offer quality information about the disease? Find out in this week’s issue of the DM Update, and learn about the different ways to delay and prevent diabetes suggested by the American Diabetes Association.

Also this week, learn about the link between berry consumption and Parkinson’s disease.

Case management, the medical home, telehealth and other efforts are helping to move volume, improve quality, reduce cost through greater throughput and reduce consumption of resources, explains Steven Valentine, president of The Camden Group.

What becomes key, and what is mentioned in the NCQA guiding principles, is the primary care base. We need to get primary care a big enough base — multiple access points that we believe will drive up the cost of acquiring primary care physicians (PCPs) and medical groups. We anticipate that within the next few years, we’ll begin to see an oversupply of specialists in a few areas as ACOs take hold and begin to reduce referrals to the specialists, which means we have to consolidate both specialists and hospitals because again, we will see a shrinkage — a reduction in inpatient use.

For any medical group looking at an ACO today, the greatest cost reduction opportunity is in inpatient utilization first, pharmaceuticals second and emergency room (ER) use third. The strategic thrust of most organizations is to broaden the base, which is attacking market share through an adequate primary care base and having the specialists and tertiary facilities be the throughput areas that they focus on for efficiencies. We see the ACO as providing a continuum of care. You know you’re on the hook for clinical care management, capturing the data across this continuum of care and measuring and monitoring your cost and quality. It’s no longer good enough to deliver better quality; you’ll have to do it below a certain cost threshold to drive greater value.

Some of the models of integration being pursued in 2011 would be hospitals moving from centers of excellence and specialty institutes and becoming more like an integrated delivery system. You might think of the Kaiser Health System or a few others around the country as truly integrated. Kaiser as well as other health plans are going to seek to own or operate the delivery system. We do see opportunities with specialty co-management agreements as precursors to filling in and getting into bundled payments, where we’ve seen much activity. We anticipate there will be more bundled payment activity starting in 2011 because we have seen in the demonstrations — the five pilots — that market share has moved in those markets. Those that were designated did gain a competitive advantage and are also working with commercial plans besides just the Medicare pilot. We also see the clinical integration developing and taking off. This is the effort to reduce costs through clinical resource consumption. Or we see the medical foundation, which is the same as an employed model around the country. We’ve seen more physicians seeking to join health systems, participate in bundled payments and participate in clinical integration.

Bundled payments attach the hospital and physician payment together for a specified period of time. That would include post-acute care and in some cases pre-hospitalization, but it does articulate a defined period of time accountable for delivering care and covering certain services and procedures. But by having a fixed case payment rate, we see a great effort to try to reduce the consumption of resources, shorten the hospitalization through case management and protocols, and getting the doctors into gain-sharing mode and gain-sharing thinking versus the doctors coming together with the hospital and thinking they could charge higher prices by coming together. That’s not the intent; the intent is to have a gain-sharing model, which is one of the major themes of healthcare reform.

In a co-management agreement, physicians come together with the hospital, forming an actual management company and then managing a department or service line. We have seen this be effective in the orthopedic and cardiovascular arenas.

If water bottles and gift cards no longer cut it with individuals suffering from chronic illness, try offering a medical home at their office, suggests Neal Sofian, director of member engagement at Premera Health. A workplace medical home was just one of several refreshing new spins on health and wellness incentives proposed by Sofian during this week’s webinar on Evaluating Health and Wellness Incentive Programs for Behavior Change.

“I am very much in favor of moving the care and changing the structure of care, in terms of an incentive for chronic illness,” Sofian said. “In the market, we’ve seen that when you can create medical homes at the workplace, make them free for the consumer, salary the physician and then only incent the physicians or provider, it creates a set of incentives that drive the physician and the member together. It eliminates a lot of specialty care cost, because it’s reestablishing a primary care relationship.

“The incentives are now lying between the consumer, the provider and the employer to drive much better adherence around chronic care management. They are only incented around quality incomes like levels of participation in chronic care, levels of participation in pharmaceutical support, completing preventive care screenings and participating in health assessment biometrics.”

Q. (Kaiser Health News): What has been the biggest thing that you’ve been able to change to keep costs from rising so quickly?

A. (Armstrong) The change in our primary care practice, often referred to as a medical home, is a great example. We have changed the schedule patterns for our primary care providers basically giving them much more time with every patient. We’ve changed how our nurses and pharmacists work collaboratively with our primary care doctors to manage the care for a panel of patients.

We are reaching out to patients who are overdue for visits, scheduling time for e-mail and phone visits and overall being a much more assertive coordinator of our patients’ care. The results have been amazing, … showing that investing in primary care in an integrated system like this will drive — by almost 20 percent — emergency room visits down, will drive hospital utilization down by more than 10 percent.

Armstrong echoes the sentiments expressed by Michael Erikson, Group Health’s VP of primary care services, two years ago when he walked through the results from Group Health’s medical home pilot during a 2009 Healthcare Intelligence Network webinar. Even then, many were calling the cooperative “a model for healthcare reform:”

At that time, Erikson said the critical elements of the medical home pilot included call management (using the most underutilized technology, the telephone); visit access, virtual medicine, chronic disease management, visit preparation, an outreach workcell, and smaller patient panels for providers.

Erikson also said that at the one-year point, ER and urgent care visits were down 29 percent and avoidable hospitalizations for chronic illnesses were down 11 percent. It looks like the model continues to perform today, since Armstrong reported similar reductions in this week’s interview.

Armstrong also shared some novels ways in which Group Health engages its patients in treatment decisions  including the use of DVDs and has increased patient satisfaction in the process:

We have about a dozen specialty procedures where we are making the time to, through the use of DVDs and through interviews with our providers, involve our patient in an objective evaluation of two, three, four different alternative therapies or approaches to dealing with their issue whether it’s hysterectomies, knee replacements other joint replacements.

In some of these high-volume procedures, we’re seeing a 10-to-12-percent drop in the procedure rate itself. We’re finding that patients are thrilled to be involved and to know really what the implications of these choices are. We’re finding that the providers are very gratified by the fact that they are able to engage in this dialogue with their patients.

It will be interesting to see whether the number of health co-ops increases in the coming years. The health reform bill provides for federal loans to fund Consumer Operated and Oriented Plans (a.k.a. co-ops), but there are actually very few health co-ops in the country today.

This week’s issue of the DM Update is focused on strokes and heart attacks. Learn how a woman’s family history can dictate if she is at risk for heart attack or stroke, and how a patient with high blood pressure and cholesterol could be at risk for both conditions.

On the research front, read about a particular population that receives more aggressive stroke treatments and has a better stroke survival rate than other populations.

The healthcare industry isn’t waiting for clarity from CMS on ACOs to lay the groundwork for accountable care organizations, according to 200 healthcare companies responding to our ACO readiness assessment. Preliminary data from the survey indicate that nearly 13 percent already belong to an ACO, with almost two-thirds of these ACOs on board for CMS’s 2012 Shared Savings Program. Another 40 percent say they will launch an ACO in the coming year.

To receive a summary of ACO adoption metrics from 200 respondents as well as data on ACO membership, reimbursement models and EHR use, take the ACO survey by February 18.

The Queens County Medical Society IPA is the chassis driving its evolution into an accountable care organization, explains Jeffrey R. Ruggiero, Esq., a legal advisor for Queens County Medical Society’s ACO development process.

Why did the Queens County Medical Society form an independent practice association (IPA)? And what is an IPA? An IPA traditionally is an independent practice association, which is a rather loose affiliation of physicians that come together for the purpose of engaging in joint managed care contracting. In this case, that is not what this IPA is going to be doing. This IPA merely is a legal structure that forms a conduit or a vehicle for the purpose of evolving into an accountable care organization (ACO). At this stage, the Queens County IPA will not be engaging in commercial managed care contracting, but rather developing an organizational structure for the purpose of participating in the CMS Shared Savings Program as an ACO.

The difference between an IPA and an ACO is that IPAs have traditionally been loosely structured. That’s probably the reason why they’ve had some mixed success, because they aren’t sufficiently integrated to be able to achieve efficiencies and utilization management and therefore have not done well economically.

An ACO has to be a much tighter structure. There has to be buy-in by the participants and agreement to formulate and abide by utilization standards, which need to be strictly imposed on the participating physicians. They also have to agree in advance to clinical protocols and guidelines and to the use of health IT and electronic health records (EHRs). These are all components that may or may not exist in a traditional IPA loosely affiliated structure.

The Queens County IPA/ACO will be managed and operated strictly by physicians for the benefit of physicians, and that’s an important feature. Once the physicians are selected that are capable of managing and leading other physicians, you have to empower those physicians to fulfill those obligations and take on the task of leading and managing their fellows and colleagues in this effort.

Good news last month for 62 regional extension centers (RECs) helping healthcare providers with adoption of electronic health records (EHRs): the Office of the National Coordinator for Health IT expanded from two years to four years the time period in which it will pick up the tab for most of the centers’ costs.

This announcement coincided with the release of our 2011 healthcare performance benchmarks in telehealth, in which EHRs topped the list of non-clinical telehealth applications. And as you’ll see in this issue’sChart of the Week, more than two-thirds of 2010 survey respondents monitor patients and health plan members remotely. Likely candidates are those with heart failure, diabetes or COPD; their weight, vital signs and medication adherence are the top activities monitored at a distance.

Download this FREE report for data on the top clinical targets of healthcare case managers; the top means of identifying and stratifying individuals for case management; and the most common locations of embedded or colocated case managers.